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4.12 Long-Term Care Providers
A nursing facility, home health services provider, or any other similar long-term care services provider that is Medicare-certified must:
• Seek reimbursement from Medicare before billing Texas Medicaid for services provided to an individual who is eligible to receive similar services under the Medicare program.
•Appeal Medicare claim denials for payment, as directed by the department.
A nursing facility, home health services provider, or any other similar long-term care services provider that is Medicare-certified is not required to seek reimbursement from Medicare before billing Texas Medicaid for a person who is Medicare-eligible and has been determined to not be homebound.
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